Ecologically Based Family Therapy (EBFT)

Scientific Rating:
2
Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Ecologically Based Family Therapy (EBFT) has been rated by the CEBC in the area of: Substance Abuse Treatment (Adolescent).

Target Population: Substance-abusing runaway adolescents (12-17) and their family members who are willing to have the adolescents live in their homes

For children/adolescents ages: 12 – 17

For parents/caregivers of children ages: 12 – 17

Brief Description

EBFT addresses multiple ecological systems and originated from the therapeutic work with substance-abusing adolescents who have run away from home. The treatment was developed to address immediate needs, to resolve the crisis of running away, and to facilitate emotional re-connection through communication and problem solving skills among family members. Family interaction is a necessary target of the therapeutic techniques. Therapy relies on understanding the individual, interpersonal, and environmental context as well as the unique resources and needs of the family and its members. The intervention includes family systems techniques such as reframes, relabels, and relational interpretations; communication skills training; and conflict resolution, but also therapeutic case management in which systems outside the family are directly targeted. The model includes 12 home-based (or office-based) family therapy sessions and 2-4 individual HIV prevention sessions.

Program Goals:

The goals for Ecologically Based Family Therapy (EBFT) are:

  • Reduction and prevention of adolescent substance use
  • Reduction of family conflict and episodes of adolescent running away
  • Reduction of other symptoms, including adolescent's internalizing and externalizing problems
  • Improvement of communication and emotional connection among family members

Essential Components

The essential components of Ecologically Based Family Therapy (EBFT) include:

  • Being based on the recognition that substance use and related individual and family problems derive from many sources of influence and occur in the context of intra-, inter- and extra-personal systems
  • Making the following assumptions:
    • The family is the primary system in a person’s life.
    • All family members contribute to the development, maintenance, and resolution of problems among its members.
    • Involvement of family members in the treatment of problems considered intrapersonal (e.g., substance use) will enhance positive individual, family, and social outcomes.
    • Because the family and its members are nested within the larger social system, dysfunction in the primary (family) setting will impact functioning in other settings.
    • Intervention does not focus solely on the individual, but on the social interactions among all participants that create the type of skill sets and emotional baseline for use in social interactions within and across systems.
  • EBFT is individually tailored to the needs of the family, as identified by assessing the family’s needs, strengths, and weaknesses.

Child/Adolescent Services

Ecologically Based Family Therapy (EBFT) directly provides services to children/adolescents and addresses the following:

  • Substance-abusing runaway behavior, sexual risk-taking, delinquency, and victim of abuse, trauma, or domestic violence

Parent/Caregiver Services

Ecologically Based Family Therapy (EBFT) directly provides services to parents/caregivers and addresses the following:

  • Substance-abusing runaway adolescent dependent, family conflict, disengagement between family members, abuse and neglect, parental substance use and parental depression

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster/Kinship Care
  • Outpatient Clinic

Homework

Ecologically Based Family Therapy (EBFT) includes a homework component:

Homework is integrated to facilitate the application of skills, which are developed in the therapy context, to daily life. In most cases, homework is comprised of interpersonal tasks, rather than paper and pencil tasks. The tasks are creatively designed with the input of the family and should be specific enough to the issues family is facing. It is important to check in with family members at the session following assignment of homework to discuss how the task was carried out, reactions to it, successes, and failures.

Languages

Ecologically Based Family Therapy (EBFT) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Transportation to client home is needed if home-based therapy.
  • Therapy rooms are needed if office-based therapy and bus passes or tokens to help facilitate session attendance.
  • Audiotape recorders are needed for supervisory purposes for either type.
  • Therapists are usually provided cell phones so that clients can easily access the therapist in times of crisis.
  • In addition, the supervisor needs to have expertise in the social resources available in the social system to guide therapists in implementation of the case management component.

Minimum Provider Qualifications

Level of education is less important than the ability to think relationally and systemically about the issues which families present. Therapists must be able to conceptualize the situation in terms of family relations which is central to the successful resolution of any presenting problem. In the research trials primarily Master's level counselors or family therapists were utilized.

In addition, the supervisors must be able to supervise systemic family therapy and have an understanding of the social systems, particularly juvenile justice, educational system, and health care, to guide therapists in case management. Supervisors must have outstanding skills to manage family crises and risks for the youth.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training is obtained onsite or offsite

Number of days/hours:

The duration and intensity of training depend on the therapists' competence to think relationally and systemically as well as their ability to implement therapeutic skills required in the intervention. For family therapists, onsite training includes a 2-day didactic training followed by weekly role-play practice until comfort and ease with the systemic procedures has been achieved. Also, ongoing audiotape review is standard. Trainings should allow enough time for practice of skills and role-plays.

Implementation Information

Since Ecologically Based Family Therapy (EBFT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Ecologically Based Family Therapy (EBFT).

Formal Support for Implementation

There is no formal support available for implementation of Ecologically Based Family Therapy (EBFT).

Fidelity Measures

There are fidelity measures for Ecologically Based Family Therapy (EBFT) as listed below:

The fidelity measure is part of the treatment manual (see below). It is a checklist, which can be completed by an observer.

Implementation Guides or Manuals

There are implementation guides or manuals for Ecologically Based Family Therapy (EBFT) as listed below:

There is a treatment manual. The manual includes a section on training and supervision. Please contact Natasha Slesnick (slesnick.5@osu.edu) for more information or a copy of the manual.

Research on How to Implement the Program

Research has not been conducted on how to implement Ecologically Based Family Therapy (EBFT).

Relevant Published, Peer-Reviewed Research

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 6 months has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

*Slesnick, N., & Prestopnik, J. (2005). Ecologically based family therapy outcome with substance abusing runaway adolescents. Journal of Adolescence, 28(2), 277-298.

Type of Study: Randomized controlled trial
Number of Participants: 124

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 51 Hispanic, 46 Anglo, 9 African American, 5 Native American, and 13 Other
  • Gender — 73 Females and 51 Males
  • Status — Participants were recruited from two local runaway shelters in Albuquerque, NM.

Location/Institution: University of New Mexico; Albuquerque

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to either the Ecologically Based Family Therapy (EBFT) condition or the service as usual (SAU) condition. The Form 90 was used to assess the quantity and frequency of drug and alcohol use. To further validate self-reported drug use, urine toxicology screens were collected for adolescents at pretreatment and the first post-treatment follow-up point (it was beyond the financial scope of the study to collect urine samples at each follow-up point). Among other measures, psychological functioning was assessed using the Youth Self-Report of the Child Behavior Checklist (CBCL) and the Beck Depression Inventory (BDI). Overall, participants who received EBFT showed a greater reduction in overall substance use compared to those assigned to SAU. Among youth who reported physical and sexual abuse, those assigned to EBFT reported fewer problem consequences and reported a reduction in the number of different drugs used over time compared to those in SAU. Limitations of the study include the reliance on youth self-report of their family environment and their own behavior.

Length of postintervention follow-up: 6 and 12 months.

Slesnick, N., & Prestopnik, J. (2009). Comparison of family therapy outcome with alcohol-abusing, runaway adolescents. Journal of Marital & Family Therapy, 35(3), 255-277.

Type of Study: Randomized controlled trial
Number of Participants: 119

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 44% Hispanic, 29% Anglo, 11% Native American, 5% African American, and 11% Other
  • Gender — 55% Female and 45% Male
  • Status — Participants were primarily alcohol problem adolescents and their primary caretakers from two runaway shelters.

Location/Institution: Albuquerque, NM

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were assigned to either (a) home-based Ecologically Based Family Therapy (EBFT), (b) office-based Functional Family Therapy (FFT), or (c) service as usual (SAU) through the shelter. Measures included the Youth Self-Report of the Child Behavior Checklist, the computerized version of the Diagnostic Interview Schedule for Children (CDISC), the Beck Depression Inventory (BDI), and the Conflict Tactics Scale (CTS). The Form 90 was used to assess alcohol and drug patterns; urine toxicology screens were collected at pre- and posttreatment assessment to verify self-reported illicit drug use. Findings showed few significant differences between the three groups at the assessment timepoints. One limitation of the study is that it is difficult to conclude whether the findings are the result of the context of treatment (home vs. office) or of treatment condition (FFT vs. EBFT). Also the study is based on a sample of convenience, focused solely on runaway youth in the shelter system, and may not generalize to other youth. Finally, the sample is small for a study examining three treatment groups.

Length of postintervention follow-up: 6-11 months.

Slesnick, N., Erdem, G., Bartle-Haring, S., & Brigham, G. S. (2013). Intervention with substance-abusing runaway adolescents and their families: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 81(4), 600-614.

Type of Study: Randomized controlled trial
Number of Participants: 179

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 118 African American and 46 White, non-Hispanic
  • Gender — 52.5% Female and 47.5% Male
  • Status — Participants from a short-term (usually 3 days) crisis shelter and services for minor adolescents.

Location/Institution: Runaway shelter in a Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of 3 theoretically distinct interventions among substance abusing runaway adolescents and to explore individual differences in trajectories of change. Adolescents were randomly assigned to the Community Reinforcement Approach (CRA), Motivational Interviewing (MI), or Ecologically Based Family Therapy (EBFT). Measurements include the Computerized Diagnostic Interview Schedule for Children (CDISC), the Form 90 Interview, and urine screens. Results indicate significant improvement in frequency of substance use among runaways in all 3 treatment groups, with a slight increase at posttreatment. Few differences among the three treatment conditions were noted. Results indicate that CRA, EBFT, and MI are viable treatments for runaway substance-abusing adolescents. Limitations include relatively small sample size, concerns about generalizability to other locations, that participants completed less than 50% of the available sessions, and differences in the fidelity ratings between the three treatments.

Length of postintervention follow-up: 21 months.

The following studies were not included in rating EBFT on the Scientific Rating Scale...

Slesnick, N., & Prestopnik, J. (2004). Office versus home-based family therapy for runaway, alcohol abusing adolescents: Examination of factors associated with treatment attendance. Alcoholism Treatment Quarterly, 22(2), 3-19.

This randomized controlled trial examined predictors of treatment attendance for runaway, substance-abusing youth and their families. Participants were randomly assigned to either Ecologically Based Family Therapy (EBFT) or Functional Family Therapy (FFT). Measures included the Youth Self-Report of the Child Behavior Checklist (CBCL), as well as the Form 90 interview, which was the primary measure of quantity-frequency of adolescent substance use, yielding the total percent days, in the last 90, of all alcohol and drug use. More families assigned to home-based EBFT were both engaged and attended more sessions compared to families assigned to the office-based FFT. 76% of the EBFT families participated in four or more sessions, while only 50% of the families assigned to FFT participated in four or more sessions. Adolescents with externalizing problems receiving EBFT had better attendance than those receiving FFT. However, severity of the adolescent’s alcohol and drug use did not significantly predict treatment attendance in either EBFT or FFT. Notable limitations of the study include its sole focus on shelter-residing runaway youth with primary alcohol problems, as well as the findings being based upon data collected solely from the adolescents’ perspectives. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

Slesnick, N., Guo, X., & Feng, X. (2013). Change in parent- and child-reported internalizing and externalizing behaviors among substance abusing runaways: the effects of family and individual treatments. Journal of Youth and Adolescence, 42, 980-993.

Note: This randomized controlled trial uses data from the Slesnick, N., Erdem, G., Bartle-Haring, S., & Brigham, G. S. (2013) study. The current study compared three empirically supported psychotherapy interventions Motivational Interviewing (MI), the Community Reinforcement Approach (CRA), and Ecologically Based Family Therapy (EBFT) with substance abusing runaway adolescents and their primary caretaker. Measures utilized include the Computerized Diagnostic Interview Schedule for Children (CDISC), the Form 90 Substance Use Interview, the Beck Depression Inventory-II, the Youth Self-Report (YSR)/Child Behavior Checklist (CBCL) and a demographic questionnaire. Results showed that adolescents receiving MI showed a quicker reduction in internalizing and externalizing behaviors but also a quicker increase in these behaviors compared to adolescents receiving EBFT, who continued to show sustained improvements at 24 months. Limitations include attrition, missing data, convenience sampling, requirement to have a caregiver participate in treatment, adolescents were substance abusing, and family relationships and predictors associated with future runaway and homeless episodes might differ among those who do not abuse alcohol and/or drugs. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

Slesnick , N., Guo, X., Brackenhoff, B., & Feng, X. (2013). Two year predictors of runaway and homeless episodes following shelter services among substance abusing adolescents. Journal of Adolescence, 36, 787-795.

Note: This randomized controlled trial uses data from the Slesnick, N., Erdem, G., Bartle-Haring, S., & Brigham, G. S. (2013) study. The current study followed substance abusing, shelter-recruited adolescents who participated in a randomized clinical trial comparing three empirically supported psychotherapy interventions, Motivational Interviewing (MI) , the Community Reinforcement Approach (CRA) , and Ecologically Based Family Therapy (EBFT). Predictors of runaway and homeless episodes were examined over a two year period. Measures utilized include the Computerized Diagnostic Interview Schedule for Children (CDISC), the Form 90 Substance Use Interview, the Beck Depression Inventory-II, the Youth Self-Report (YSR)/Child Behavior Checklist (CBCL) and a demographic questionnaire. Results showed that substance use and family cohesion predicted future runaway and homeless episodes, but family conflict, depressive symptoms, delinquency, or school enrollment did not predict that outcome. Limitations include attrition, missing data, use of subjects form a single runaway shelter, adolescents were substance abusing, and family relationships and predictors associated with future runaway and homeless episodes might differ among those who do not abuse alcohol and/or drugs. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

Guo , X., & Slesnick, (2013). Family versus individual therapy impact on discrepancies between parents’ and adolescents’ perception over time. Journal of Marital and Family Therapy, 39(2), 182-194.

Note: This randomized controlled trial uses data from the Slesnick, N., Erdem, G., Bartle-Haring, S., & Brigham, G. S. (2013) study. This study examined the degree of disagreement between runaway adolescents and their primary caretakers, defined as informant discrepancies, on their view of their family. How these discrepancies changed over time and whether family therapy or individual therapy could impact that change were explored by comparing three empirically supported psychotherapy interventions, Motivational Enhancement Therapy (MET), the Community Reinforcement Approach (CRA) , and Ecologically Based Family Therapy (EBFT). Measures utilized include the Family Environment Scale (FES), a demographic questionnaire, and administrative data on session completed. Results showed that among those receiving EBFT, but not CRA or MET, informant discrepancies decreased significantly over time. Additionally, dyads with a male adolescent showed a significantly slower rate of improvement in discrepancy scores across time compared with dyads with a female adolescent. Limitations include that the direction of the discrepancy cannot be determined by the statistical methods used in the study, the somewhat low reliabilities of the FES subscales, and that results may not be generalizable to other populations, as families with a substance abusing runaway adolescent have long been recognized to represent some of the most distressed families. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

Guo , X., Slesnick, N., & Feng, X. (2014). Reduction in depressive symptoms among substance-abusing runaway adolescents and their primary caretakers: A randomized clinical trial. Journal of Family Psychology, 28(1), 98-105.

Note: This randomized controlled trial uses data from the Slesnick, N., Erdem, G., Bartle-Haring, S., & Brigham, G. S. (2013) study. This study compared the effects of Ecologically Based Family Therapy (EBFT) with two individually based substance abuse interventions, the Community Reinforcement Approach (CRA) and Motivational Enhancement Therapy (MET), on runaway adolescents’ and their primary caregivers’ depressive symptoms. Subjects were randomly assigned to one of the three interventions. Measures include the Computerized Diagnostic Interview Schedule for Children (CDISC), the Form 90 Substance Use Interview, the Beck Depression Inventory-II, and the Youth Self-Report (YSR)/Child Behavior Checklist (CBCL). Results showed that youth’s depressive symptoms were significantly reduced in each treatment to 2 years postbaseline. However, the trajectory of change differed across treatments, with adolescents receiving MET showing a more rapid reduction in depressive symptoms, but a quicker increase in symptoms compared with adolescents receiving EBFT. Caregivers receiving EBFT showed a statistically significant decline in depressive symptoms, but this was not observed for the CRA and MET conditions. Limitations include the small sample size within each treatment group and, concerns about generalizability beyond the single runaway shelter the sample was drawn from, attrition rates, and missing data. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

References

Slesnick, N. (2000). Treatment manual: Ecologically-Based Family Therapy for substance abusing runaway youth. Unpublished manuscript.

Slesnick, N. (2001). Variables associated with therapy attendance in runaway substance abusing youth: Preliminary findings. American Journal of Family Therapy, 29(5), 411-420.

Contact Information

Name: Natasha Slesnick, PhD
Title: Professor
Agency/Affiliation: The Ohio State University
Department: Department of Human Development and Family Science
Email:
Phone: (614) 247-8469
Fax: (614) 292-4365

Date Research Evidence Last Reviewed by CEBC: March 2016

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: April 2010